WHA's Behavioral Health Providers
*For UC employees: Behavioral health and substance abuse benefits have been carved-out by the employer and are managed by Optum Health. You may contact Optum Health directly at (888) 440-8225 or visit their website at https://www.liveandworkwell.com/public/
If your WHA patients require behavioral health (BH) services, Magellan Behavioral Health Services can help. WHA members have access to on-line resources and telephonic assistance by calling the phone number listed below. WHA delegates all BH services, related claims processing, and management of member grievance and appeals to Magellan for members covered by this provider*. As a WHA provider, you have the ability to check the status of a claim, request or view an authorization, and have access to a variety of resources.
Although WHA members may self-refer for BH services, they must first contact Magellan to obtain prior authorization. Magellan offers appointment assistance services to ensure timely appointments with BH specialists. This can be initiated by the patient or their PCP.
Collaboration between Medical Care and Behavioral Healthcare Providers
If your patient is known to be receiving BH services, the medical information you have on this patient can be invaluable to a BH provider. Collaboration between medical and BH services enhances the overall health of the patient by connecting the physiological well-being with the psychosocial well-being of the patient. It is also a requirement of the National Committee for Quality Assurance (NCQA).
Information provided to the patient's primary care healthcare provider on the patient's progress is also important. If the patient self-referred, members can sign a form giving permission to the BH provider to notify the PCP that he or she is receiving BH services. Where there are medical and behavioral co-morbidities, Magellan attempts to outreach patients to ensure this collaboration of care occurs.
We encourage both medical and BH providers to communicate relevant patient information to better serve our members.
Member Contact Information
Note: The following contact information can also be found on the back of the member's ID card.
Provider Contact Information
(800) 430-0535 Option 4
Appointment Access Standards1
- Life-Threatening Emergency Access - If you are unable to see a member with a life-threatening emergency immediately, we ask that you immediately refer the member to the nearest emergency room, or advise the member to call 911.
- Non-Life-Threatening Emergency Access - We expect you to offer members with non-life-threatening emergencies an appointment within six hours of their request for services.
- Urgent Access - We expect you to offer health plan and other managed care members with urgent situations an appointment within 48 hours of contact, and EAP members with urgent situations within 24 hours of contact.
- Routine Access - We expect you to offer health plan and other managed care members for routine care an appointment within 10 business days of contact, and EAP members for routine care within three business days of contact.
- Unavailability - Notify us immediately whenever you become unavailable for new referrals; let us know when you become available again.
If a member requires interpreter services, Magellan will coordinate with you to ensure interpreter services are available to the member at the time of the appointment.
Telephone Access Standards
If you are unavailable when a member calls, we expect that you return the member's call within no more than two business days and that you communicate your standard telephone response time to members via your phone message and/or answering service.
In-Office Wait Times
Members should not have to wait more than 15 minutes after the scheduled appointment time except when an emergency interrupts your schedule. Again additional clarification surrounding Magellan's standards can be found in the California Provider Handbook Supplement. We thank you for your commitment to providing quality care to our members.
1 As published in the Provider Focus Newsletter, Fall 2010.
** Two Magellan subsidiaries, Magellan Health Services of California, Inc. -- Employer Services and Human Affairs International of California, operate out of the California Care Management Center. References in this article to "Magellan" are to these two subsidiaries.